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NSG 533 > Exam 1- Mens And Womens Health > Flashcards

Exam 1- Mens And Womens Health Flashcards

1
Q

What are some medications that are contraindicated in pregnancy?

A

-ACE inhibitors
- warfarin
- valporic acid
- carbamazepine( epilepsy)
- statins
- ARBS ( End in sartan)
- methotrexate ( cancer med)
- tetracycline
- isotretinoin ( acne med)
- NSAIDS ( naproxen, ibuprofen.) pregos= no Advil

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2
Q

What are medications that are safe alternatives that pregnant women can take?

A
  • instead of ACE = beta blockers
  • clindamycin for acne
  • Tylenol for pain
  • heparin
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3
Q

What are medications that are safe alternatives that pregnant women can take?

A
  • instead of ACE = beta blockers
  • clindamycin for acne
  • Tylenol for pain
  • heparin
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4
Q

What are some contraindications of contraceptive use?

A
  • DVT, stroke, heart attack
  • breast cancer
  • hypertension
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5
Q

Who should not be taking contraceptives?

A
  • suspected or known pregnancies
  • current breast cancer
  • risk or current DVT
  • hypertension
  • stroke
  • old age, smoking, breastfeeding
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6
Q

Management of side effects because of contraceptives

A
  • Acne= switch to progresteone ( ex noerthinadone)
  • headache= stop contraceptive, or decrease estrogen/ progesterone
  • weight gain = switch to progesterone( ex noerthinadone)
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7
Q

Common drug interactions with contraceptives

A
  • st. John’s wort
    -Seizure medication ( carbamazepine, phenobarbital)
  • lamotrigine
  • meds ending in -vir
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8
Q

What are some signs and symptoms of menopause?

A

( menopause= no periods for 12 months straight)

  • vasomotor symptoms: hot flashes and night sweats
  • vulvovaginal atrophy: drying, thinning, and inflammation of vaginal walls
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9
Q

What is the management of vasomotor symptoms?

A

Estrogen/ progesterone therapy
SNRI & SSRI
gabapentin for night sweats
Clonidine
Maintain cool environment, light clothing, avoid hot drinks or alcohol

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10
Q

What is the management of valvovaginal atrophy

A

vaginal creams, tablets, gels ( estradiol)

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11
Q

If hormone replacement therapy is used for menopausal symptoms, when and why must a progestin combined with an estrogen?

A

It must be combined and women who have an intact uterus to prevent endometrial hyperplasia and endometrial cancer

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12
Q

What are some benefits of hormone replacement therapy?

A
  • reduces hot flashes and night sweats
  • improvement of vulvovaginal atrophy
  • improves mood and sleep
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13
Q

What are other signs and symptoms of menopause?

A
  • mood changes ( irritability)
  • sleep disturbances ( insomnia)
  • difficulty, concentrating and memory problems
  • decreased sexual desire
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14
Q

What are some risks of hormone replacement therapy?

A
  • DVT, PE, stroke
  • breast cancer
  • MI
  • endometrial cancer
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15
Q

What are some contraindications of hormone replacement therapy/when should it not be used?

A
  • undiagnosed vaginal bleeding ( test test to be done to rule out cancer)
  • Known or suspected breast cancer
  • Active endometrial cancer
  • DVT
  • MI
  • Pregnancy
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16
Q

What are some relative contraindications of hormone replacement therapy/it should be used with caution?

A
  • controlled hypertension
  • family history of breast cancer
  • migraine headaches ( increased risk of stroke)
  • Diabetes
  • history of endometriosis
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17
Q

What do the current guidelines say about dose of hormone replacement therapy?

A
  • estrogen should be used at the lowest effective dose for a shortest, duration necessary to achieve treatment goals
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18
Q

When is it recommended to use hormone therapy for a short term?

A

To manage, moderate to severe menopausal symptoms, like hot flashes and vaginal atrophy

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19
Q

Hormone therapy should be limited to less than how many years

A

Less than 5 years

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20
Q

Terazosin

A

Think teraGOOOOsin and teraSLOWsin. TeraLOWsin

Helps go to the bathroom. make sure slow position changes cause or orthostatic hypertension. Can lower BP

OK to have grapefruit ( one of the only meds where that is ok)

Do not take antacids ( avoid antacids with all meds)

Do not take sildanafil while on terazosin ( both meds can lower bp. Sildanafil can kill)

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21
Q

Oxybutynin

A
  • oxybladder, overactive bladder
    Dries the body
    Low bp
    Cant see, shit, pee, spit
    Constipation
    Dry eyes dry mouth
    Body is dry but labs like potassium are high
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22
Q

What is BPH

A

Enlarged prostrate which puts pressure on the urethra (which runs thru prostrate ) so causes urinary symptoms

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23
Q

2 classes of BPH meds

A
  • androgen inhibitor= finasteride ( BPH and bladder) reduces size of prostate
  • peripherally acting antiadrenergics= tamsulosin and doxazosin
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24
Q

Side effects of finasteride

A
  • erectile dysfunction
  • gynecomastia ( development of breast tissue in men)

• think of checking out guy in a fine ride= but is bald and has bph and has male breasts and ED

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25
Q

What medications can lead to the development or worsen BPH/ erectile dysfunction

A
  • H2RA and PPI
  • drugs like marijuana or cocaine
  • Seizure medications
  • antidepressants/antipsychotics
  • beta blockers
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26
Q

What are some medications for erectile dysfunction?

A
  • sildenafil and tadalafil

Think fil fills up penis

27
Q

What are the treatment options for BPH based on AUSSAI

A
  • less than 7= watchful waiting, recheck in 3-6 months
  • more than 8= alpha blocker
  • more than 20= surgical therapy
28
Q

What are some side effects of erectile dysfunction medication’s?

A
  • priapism ( prolonged erection)
  • increased risk for myocardial infarction
  • educate patients not to take this medication with any other nitrates including nitroglycerin, which could increase the risk of having a myocardial infarction
  • use erectile dysfunction medication’s ( fil) cautiously and men with cardiovascular disease
29
Q

What are some labs to monitor for BPH?

A
  • prostate specific antigen ( PSA)
  • renal function tests
30
Q

What is the first line therapy for BPH?

A
  • alpha 1 adrenergic receptor antagonist
    ( terazosin, tamsulosin, doxazosin)
  • 5 alpha reductase inhibitors
    ( finasteride)
31
Q

When is it OK to start combination therapy for BPH?

A
  • If symptoms persist despite alpha block therapy, then adding a 5ARI maybe needed, especially in men with larger prostates
  • men with disease progression, including those with bothersome symptoms
  • high PSA levels are rapidly rising levels
32
Q

What are the first line medication therapy for generalized anxiety disorder?

A

SSRI ( Zoloft, Lexapro, Paxil, Prozac)
SNRI ( Effexor and cymbalta)
Buspar

33
Q

What are the first class medications for major depressive disorder?

A

SSRI ( Zoloft, lexapro, Prozac, Paxil, celexa)
SNRI ( Effexor and cymbalta)
Buspar

34
Q

SSRI meds

A
  • end in tine/ sounds like teen ( fluoxetine, sertraline, paroxetine)
    • think of if you live with a teen there’s times when you may need to be out on meds for anxiety or depression
  • work by inhibiting serotonin reuptake which increases the amount of serotonin in the system
  • side effects: sexual dysfunction, weight gain, insomnia
  • black box warning: can increase suicidal thoughts in some patients
35
Q

What do you need to monitor in a patient that is taking SSRI

A

Monitor for serotonin syndrome!
( agitation, hallucinations, fever, sweating, tremors. Everything’s amped up)
- do not take SSRI with st johns wort- can increase risk for getting serotonin syndrome

36
Q

SNRI meds

A
  • inhibiting reuptake of both serotonin and norepinephrine ( increases both in the body)
  • duloxetine and venlafaxine. Aka cymbalta and Effexor)
  • side effects : fatigue, insomnia, stomach upset including constipation, dysuria, decreased libido ( low sex drive)
  • black box warning: suicidal thoughts
  • monitor for serotonin syndrome
37
Q

What are contraindications for some other drug classes that can be used for depression and anxiety?

A

-Benzos ( Ativan, Xanax) : substance abuse
- Tricyclic antidepressants ( TCA) ( amitriptyline) : cardiac arrhythmia
- atypical antipsychotic ( seroquel, abilify, zyprexa) : cardiovascular disease, diabetes
- MAOI ( nardil) : other antidepressants, cardiovascular disease, liver disease

38
Q

Management of serotonin syndrome

A
  • discontinue medication and supplements that are contributing to serotonin excess
  • IV fluids to maintain hydration
  • meds to control, agitation, and seizures like benzos
39
Q

How long does it take for antidepressants to work?

A

4-6 weeks
When patients don’t show much improvement after that time, then you can go to the next treatment
- side effects occur quickly

40
Q

How long should a trial be for anti-depressants at a therapeutic dose before deciding whether they have worked

A

Trial of 8- 12 weeks

41
Q

Fluoxetine and MAOI wash out period

A

prozac must be stopped ( or have a washout period) 4-5 weeks before MAOI can be started

42
Q

Buspar is good for

A

Major depressive disorder, anxiety, smoking cessation

43
Q

How is buspar different than SSRI and SNRI

A
  • It inhibits the reuptake of both norepinephrine and dopamine unlike SSRINSNRI that primarily target serotonin
  • preferred and patients experiencing fatigue and lethargy associated with depression
  • less likely to cause sedation compared to other antidepressants
  • contraindicated and patients with a history of seizures or conditions that increase the risk of seizures like alcohol withdrawal or head trauma. The risk of seizure increases with buspar
44
Q

What are the contraindications for BuSpar? What patient should not take it?

A
  • history of seizures
  • mania or bipolar disorder ( may induce manic or hypo manic episodes. Should be used cautiously and preferably in combination with a mood stabilizer for a patient with bipolar disorder)
  • Renal impairments
45
Q

How do MAOIs work?

A

Inhibits and enzyme ( monoamine oxidase) responsible for breaking down, neurotransmitters like serotonin and dopamine and norepinephrine which increases the levels in the brain

46
Q

What are drug interactions with MAOIs?

A
  • can cause serotonin syndrome when mixed with SSRIs and SNRIS and tricyclic
  • can interact with tryamine rich foods like aged cheese, cured meats, fermented foods, and certain alcoholic beverages
47
Q

What is the wine and cheese reaction of MAOIs?

A
  • with MAOI , Tyramine is not metabolized leading to excess tyramine in the bloodstream. Eating Foods like aged cheese and wines, which are high in tyramine can lead to a sudden increase in blood pressure known as hypertensive crisis ( chest pain, severe headache, palpitations, nausea, vomiting)
48
Q

For benzodiazepines and anxiety related disorders, how long until the antidepressant begins to work?

A

2-4 weeks

49
Q

Why is long-term use of benzodiazepines not recommended

A

Because of concerns regarding dependence and withdrawal symptoms

50
Q

What medication’s that have a short life are recommended for elderly people

A
  • short acting benzodiazepines ( Ativan)
  • short acting opiods ( oxycodone, hydrocodone)
51
Q

What medications with the long half-life are not recommended for elderly people

A
  • long acting benzodiazepine ( diazepam)
  • long acting opioids ( methadone, fentanyl)
52
Q

How is Buspar different than benzos?

A

It doesn’t have addiction potential it makes it suitable for a long-term anxiety management
- patient education should be focused on delayed onset, and importance of consistent dosing

53
Q

Why are some benzos called Z hypnotics

A

Most of them start with Z ( Zolpidem aka ambien, Zaleplon)

They have sleep inducing properties
These are generally indicated for short-term treatment of insomnia, usually 7 to 10 days due to concerns about dependence or rebound insomnia with long-term use

54
Q

What are the benefits of Z hypnotics ( benzos for insomnia)

A

Rapid onset

55
Q

What type of insomnia medication should be avoided and older adults

A
  • long acting benzodiazepines ( zolpidem extended release, temazepam, estazolam) because they caused daytimes sedation and impair cognition so they increase the risk of falls
56
Q

What population should be closely monitored in the administration of hypnotics

A
  • elderly, pregnancy, liver and kidney disease, pulmonary disease, including sleep apnea
57
Q

What medications can cause BPH

A
  • anticholinergics ( oxybutynin)
  • decongestants ( ex sudafed)
  • antihistamine ( Benadryl)
  • Diuretics
  • Psychotics and antidepressants
58
Q

For a patient experiencing their first episode of depression, how many full months of antidepressant therapy to reach full remission

A

6-12 months to prevent relapse

59
Q

Side effects of trazodone for insomnia

A

Orthostatic hypotension, sedation, dry mouth, dizziness, constipation, or diarrhea

60
Q

What is a class of antidepressants that would be dangerous in overdose

A

Amtriptyline

TCASs ( tricyclic antidepressants) - have a narrow therapeutic index so there is a small difference between a therapeutic dose and a toxic dose. More dangerous than other antidepressants like SSRI

61
Q

What to monitor in Effexor

A
  • blood pressure ( can increase)
  • Heart rate( can increase )
62
Q

When is pregabalin a preferred treatment in a patient with generalized anxiety disorder

A
  • when first line treatments like SSRI or SNRIs haven’t worked or weren’t tolerated
63
Q

When is pregabalin a preferred treatment in a patient with generalized anxiety disorder

A
  • when first line treatments like SSRI or SNRIs haven’t worked or weren’t tolerated
64
Q

What side effects are associated with seroquel

A

Weight gain, sedation, fatigue

NSG 533 (4 decks)

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